SSKIN: 5 Steps to Prevent Pressure Ulcers

Pressure injuries are also known as pressure ulcers, pressure sores or bed sores. Anyone who's dealt with them will know they can be painful, uncomfortable, and difficult to treat once they develop. The good news is that many pressure ulcers can be prevented or their effects managed.

If you’re caring for someone with limited mobility, they can be at risk of developing a pressure injury, so you may have heard of SSKIN. It’s a widely used approach to pressure ulcer prevention in the NHS, and it can be just as useful at home.

Here, Opera Beds explores what SSKIN stands for and the five simple steps you can follow to reduce the risk of pressure injuries developing.

What is SSKIN?

SSKIN is a framework used in care settings to help prevent pressure ulcers. It’s designed to support skin health, reduce prolonged pressure on vulnerable areas, and encourage early intervention if signs of damage appear.

What does SSKIN Stand for? 

SSKIN stands for: 

• S – Skin integrity

• S – Surface

• K – Keep moving

• I – Incontinence

• N – Nutrition

Each step focuses on one of the key causes of pressure ulcers. When used together, they create a practical routine that supports prevention and comfort.

What are Pressure Injuries?

Pressure ulcers occur when the skin and underlying tissues are damaged. Pressure injuries can occur due to shear, where the body is pulled in one direction against the support surface (e.g. mattress), causing static. Shearing is what happens when the skin remains stuck to the surface while the skeleton moves over it – thinning and kinking blood vessels, reducing blood flow. 

Friction is another common cause of pressure injuries. This happens when the skin is rubbed against a surface, e.g. a seat cushion, and the outer layers of the skin become damaged. 

In more serious cases of pressure injuries, the damage can extend deeper into the muscle and even the bone.

These sores usually develop when someone stays in one position for too long without moving or changing position regularly.

In order of their likelihood of occurring, pressure ulcers are most likely to form over bony areas of the body, such as:

• Sacrum or Coccyx 

• Hips 

• Sitting bones (ischial tuberosities)

• Heels 

• Ankles 

• Elbows, shoulders

• Back of the head

Early Signs of Pressure Injuries to Look Out for

The earlier pressure damage is spotted, the easier it is to prevent it from becoming serious.

Early symptoms can include:

• Red or discoloured patches of skin that do not fade

• Swelling

• Skin that feels warmer or cooler than normal

• Skin that feels harder than the surrounding areas

• Blistering or broken skin

It’s also important to note that pressure injuries can be harder to spot on darker skin tones, so you should also be especially aware of symptoms like: 

• Discoloured patches

• Temperature changes

• Hardness of skin or softer areas

• Pain

• Areas not fading when pressed 

• Itchy patches of skin 

If you notice any of these changes, seek advice from a healthcare professional as soon as possible.

How Long Does it Take for a Pressure Ulcer to Develop?

According to the NHS, pressure injuries develop gradually but can sometimes appear over a few hours if there is constant, unrelieved pressure on bony areas. This can cut off blood flow, depriving the area of oxygen and nutrients, damaging the skin and tissue. 

Who is Most at Risk of Developing Pressure Injuries?

Pressure ulcers are more likely to affect people who have reduced movement or limited sensation, including those who are:

• Spending long periods in bed or a chair

• Recovering from surgery or illness

• Living with paralysis or nerve damage

• Experiencing incontinence

• Older adults with fragile skin

• Living with conditions that affect circulation (such as diabetes)

Even if someone appears comfortable, pressure damage can develop quietly, especially if they are unable to feel pain in certain areas.

Explore more about pressure injuries in The Complete Guide to Pressure Ulcers.

The SSKIN approach: 5 Steps to Prevent Pressure Injuries

The SSKIN framework is effective because it covers all major factors that contribute to pressure ulcers, including: 

1. Skin Integrity (checking the skin regularly)

Skin checks are a vital part of preventing pressure ulcers. Even small changes can be a warning sign that pressure is building.

When checking the skin, look for:

• Discolouration that doesn’t fade when pressed

• Warm patches or unusual coolness

• Swelling

• Dryness or broken skin

• Complaints of pain, itching or tenderness

Remember that symptoms may be different on darker skin tones, so pay close attention to things like temperature changes, differences in texture and discolouration. 

Pay close attention to areas such as the sacrum or coccyx, the hips, sitting bones (ischial tuberosities), heels, ankles, elbows, shoulders, and the back of the head.

Tip for Carers

If someone struggles to check their own skin, a mirror can help, especially for hard-to-see areas like the back or buttocks.

2. Surface (Using the Right Mattress, Cushions and Bedding)

The “surface” element of SSKIN refers to anything the body rests on – including mattresses, chairs, pillows and bedding.

A poor surface, that doesn’t adequately  can concentrate pressure on one area of the body. Over time, this reduces blood flow and increases the risk of tissue damage.

Why Surface Matters

Specialist pressure-relieving equipment can help distribute weight more evenly and reduce pressure build-up in vulnerable areas.

NHS guidance notes that people at risk of pressure injuries may benefit from a specially designed foam mattress or a pressure-relieving support surface.

If someone is spending a lot of time in bed or seated, it may be worth considering:

• A pressure-relieving mattress

• A chair with a supportive cushion attached

• Seeking professional support, e.g. from an occupational therapist to assess their seating and pressure needs

• Bedding that reduces friction and bunching

3. Keep Moving (Regular Repositioning and Posture Changes)

Movement is one of the most effective ways to prevent pressure ulcers because it reduces prolonged pressure and improves circulation.

Even small shifts in posture can help. 

NHS guidance recommends:

• Wheelchair users change position at least every 15-30 minutes

• People confined to bed change position at least every two hours

If someone is unable to reposition themselves due to muscle weakness or mobility issues, they may need support from a carer or family member.

Appropriate seating can also help; consider a chair with a tilt-in-space function, which helps manage posture and pressure, tilting the chair back while maintaining a consistent 90-degree angle between the seat and backrest. This redistributes body pressure, reducing the risk of ulcers, while improving posture and enhancing comfort. 

All Opera Riser Recliner Chairs feature the tilt-in-space feature as standard, ensuring consistent comfort and helping you manage the risk of pressure injuries occurring. 

How Profiling Beds Can Help

Profiling care beds can make repositioning safer and more comfortable by supporting the head, legs, and overall alignment of the body. These beds can also help users sit upright, reduce strain, and support breathing and circulation.

[Explore profiling care beds]

4. Incontinence (Keeping Skin Clean, Dry and Protected)

Incontinence is a common risk factor for pressure injuries because moisture can weaken the skin and make it more prone to breakdown.

The skin can become irritated, sore, and more vulnerable to damage if it stays damp for too long.

How to Reduce Risk

• Change continence pads regularly

• Clean the skin gently after accidents

• Use mild soap or skin-friendly cleansers

• Pat dry (rather than rubbing)

• Consider barrier creams if recommended by a professional

5. Nutrition (Supporting Skin Health from the Inside)

Nutrition is often overlooked in pressure ulcer prevention, but it can make a real difference.

Healthy skin relies on:

• Enough calories and protein

• Good hydration

• A range of vitamins and minerals

NHS guidance explains that a balanced diet can help prevent skin damage and support healing, especially when it contains enough protein and nutrients.

What if Their Appetite is Low?

For individuals recovering from illness, appetite can be reduced. If this happens, smaller meals and nutritional drinks may be helpful, and professional advice may be needed.

Even mild dehydration can affect skin health, so encouraging regular fluid intake can help prevent ulcers, too.

What Should You Do if You Think Someone has a Pressure Injury?

If you notice early signs of skin damage, it’s important to act quickly.

NHS guidance advises speaking to a healthcare professional immediately if you notice possible pressure damage, such as a nurse, GP or care team.

Avoid applying pressure to the affected area and ensure the person is repositioned comfortably while waiting for medical advice.

Barbara Franks, Opera Beds Expert and Occupational Therapist, says: 

“It’s important to remember that prevention is often about small, consistent actions, like regular repositioning and checking the skin for any signs of damage.

“The SSKIN framework works so well because it encourages carers and families to think holistically. It’s not just about the mattress or movement; it’s about looking at skin health, nutrition, moisture and positioning as a collective. When these elements are incorporated into a daily routine, the risk of pressure ulcers can be lowered.

“It's also essential that an individual's bed, chair and if they use one, their wheelchair, are considered in terms of pressure risk. This should be done in conjunction with their healthcare team.

“For people living at home, having equipment that makes repositioning easier and reduces pressure build-up can also protect independence and dignity. Using hospital beds with pressure-relieving mattresses can support safer movement and reduce physical strain on the individual and their carer.

“If there are any early signs of skin damage, or if someone is at higher risk due to reduced mobility or a medical condition, it’s important to seek advice from a healthcare professional.”

Barbara Franks is a fully qualified occupational therapist and expert witness who worked for the NHS before setting up on her own to assess clients and make recommendations that enable people to lead as independent a life as their condition allows.

How Opera Beds Can Help Support Pressure Ulcer Prevention at Home

Preventing pressure injuries isn’t just about knowing the right steps – it’s about having the right support in place every day.

Opera Beds provides practical solutions designed to help people live more comfortably and safely at home, including those with reduced mobility or long-term health conditions.

If you’re supporting someone who is at risk of pressure ulcers, the right equipment can make prevention easier and more effective, such as: 

• Pressure-relieving mattresses to reduce the risk of pressure injury and improve comfort.

• Profiling beds to support repositioning, posture changes, and safer movement

The SSKIN approach provides a simple routine that helps protect vulnerable skin, improve comfort, and support wellbeing, whether in a care home, hospital, or at home. 

However, managing and mitigating the risk of pressure injuries can be made easier with our range of pressure care mattresses, specially designed to reduce pressure points, enhance comfort, and prevent ulcers. 

Explore pressure care mattresses

If you’re unsure about the right mattress or bed setup for pressure ulcer prevention, use our Mattress Selector Tool, or to speak to someone, our customer service team can help you explore suitable options based on individual needs.